Sizing- will this sit better once it's placed? (Photo)

Question

I'm currently scheduled next week for surgery. I've tried on implants, and am debating between at 175cc moderate plus or 200 mentor silicone dual plane under muscle. I am 5'1'' 105#, breast pocket space 12.5cm. I feel like I like the volume of the 200, but it feels a little wide. I believe it is 10.5cm diameter. Will this sit better once its placed or will I always feel wide? I'm going for a natural but want to fill a swim suit nicely look.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry and excellent pictures.  I think either implant will have a natural modest look, but this is a very subjective question that only you can answer.   The 200 cc being slightly wider will accentuate side feature more but also give more fullness superiorly. There is only 1 mm projection difference between these implants but 5 mm more width.  Good luck with surgery.

Joe Gryskiewicz, MD, FACS · Answer

Hello,
Either size implant would look great. Keep in mind that when placing the implants under the muscle you will lose some volume, so if you like the 200cc but are worried it may feel too big, the size will decrease just a tad. The 175cc and 200cc diameters are smaller than your breast width diameter so you shouldn't be feeling wider. 
Best of luck,
Dr. Joe

Daniel Barrett, MD · Answer

Dear ASCHWICH,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Carlos Marciales, MD · Answer

Hello, I recommend that you choose the 200 cc, dual plane implant, the swimsuit will look much better, and it will look very natural.

Azita Madjidi, MD, MS, FACS · Answer

The difference between 175 cc and 200 cc implant diameter is only 5 mm and you cannot tell clinically. Your surgeon will place a sizer once he/she creates the pocket then measure the inside diameter before putting the implant in. So don't get hung up on the diameter measured over your skin. What matters is the diameter in the pocket that is measured during surgery. At least that is how it should be done.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Connie Hiers, MD, FACS · Answer

Both should do well for you, but I recommend the 200 cc implants just for a little more fullness. Both should look very natural and probably keep you in the B cup range.

Camille Cash, MD · Answer

Either implant should look nice on you and accomplish your goal of filling a swimsuit.  If you are more comfortable with the 200cc implant and your surgeon who has examined you feels it would be a good fit, then you should proceed with it.

Justin Booth, MD · Answer

This is a common question. The volume numbers in terms of cc’s (175 vs 200) sound greater than they actually appear in situ (in the body). In this case, the volume difference is less than an ounce, the additional projection is 1mm and the additional width is 5mm. 
That said, it is certainly different “trying on” implants versus when they are in the body. I recommend reviewing your aesthetic goals with your surgeon who can then match the implant to your goals.

Mats Hagstrom, MD (license on probation) · Answer

Quality breast documentation outcomes are based on three variables.
The first variable is the patient candidacy for the procedure.
The second variable is the choice of implants in regards to size shape and type.
The third variable is the surgeons ability to place the implant and the correct anatomic position.
 From your pictures, I would say you are an almost perfect A+ textbook candidate for breast documentation.
You have minimal breast ptosis, your nipples point forward with minimal to no divergence, and your breast sit fairly evenly on your chest wall.
For most individuals, the left breast tends to sit slightly higher than the right side.
This may be true for you as well, if you look at your inframammory folds.
Implant selection is best done with your provider.
Different plastic surgeons have very different ways of guiding patients through implant selection process.
I did not find that putting implants in your bra is a very accurate way of terminating implant size.
My personal preference is always been to use before and after pictures of previous patients who had very similar body characteristics to the patient having the procedure.
I usually have patience go through hundreds of before and after pictures and bring in examples that they think are perfect.
 Bring those pictures with me to the operating room and during surgery I use temporary sizers to determine what size implant will give the outcome. The patient has described.
I find it talking about inches, cup size or anything like that to be subjective and inaccurate.
I typically have a full selection of implants available in the operating room and select the implants based on what size gives the desired outcomes using temporary sizers.
To me, this has been the most accurate way of making the decision.
I think the surgeon has far more experience and it’s in a better position to make the final decision though obviously, there has to be an element of trust and surgeons have to take ownership and responsibility for the final decision.
Most plastic surgeons will tell you that women tend to be a little cautious and often wish they went bigger After primary augmentation.
Women who know they only want to have a modest increase should be listened to.
The volumes you mentioned are fairly conservative.
All of this said my personal preference would generally be using implants that are far smaller than what most patients want.
I generally go what patients ask for unless it seems excessive.
Using excessively large implants will definitely Lead to higher undesirable side effects, increased, complication rates, and increased revision rates.
I generally used the breast diameter to make my initial decision regarding implants.
I generally stay away from high profile implants unless the patient wants a bigger implant.
The choice regarding projection or profile should be based on how large the patient wants to go. Generally, low profile implants look more natural.
 my personal preference is to leave the implant covered by as much pectoralis muscle as possible. Still allowing the implant to sit low enough to not leave it riding high long-term.
Keeping adequate pectoralis muscle support protects the implant from long-term bottoming out.
Implants bottom out is a common undesirable side effect from violating the natural breast periphery, especially the infra-mammory fold. 
And that sense I’m not a big fan of the dual plane approach.
I recognize that you have surgery coming up pretty soon, so I don’t want to stir the emotional pot.
That said, I generally recommend patients have multiple in person consultations before selecting providers.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patient who had similar body characteristics to your own.
An experience provider should have no difficulty showing you before and after pictures of at least 50 previous patients.
Highly experienced surgeons should have access to hundreds or preferably thousands of before and after pictures.
 Being shown a handful of pre-selected images, representing all the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like, or how many of these procedures they’ve actually done.
I also recommend patients ask providers what their most common reason for revision surgery is, what their revision rates are, and especially what their revision policy is.
I would even go as far as asking providers how often they see breast implants bottom out after the procedure.
This one single outcome complication seems to be the most prevalent, and can be difficult to correct later.
There’s no correct number of consultations needed to find the right provider.
The more consultations patient schedule the more likely they are to find the better provider.
Hopefully you feel comfortable with your provider at this point and if you have questions regarding implant size, I suggest you direct them to your provider.
I don’t think it’s appropriate for us to tell you what implant size to use.
I wouldn’t want other plastic surgeons, telling my patients what implants to use as well.
I will again mention that anatomically you are a textbook perfect candidate for breast documentation. A lot of women do not recognize that they have significant breast divergence, and this is often amplified with the projection from implants.
In the hands of the right provider, you should look forward to a stellar outcome.
 Finally it is always safer and a better long-term strategy to not go too big on breast implants.
This is true when making your primary decision, and it is even more true, when patients contemplate having increased size revision surgery in the future.
Good luck with your upcoming procedure.
Best,
Mats Hagstrom, MD

Sizing- will this sit better once it's placed? (Photo)

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